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Attention Deficit Disorder

Alternate Names

  • ADD

Definition

Attention deficit disorder (ADD), is the old name for a disorder in which a person shows a certain pattern of behavior over time. This pattern includes inattention and impulsivity. Attention deficit / hyperactivity disorder, (AD/HD) as it is now called, is characterized by physical hyperactivity, impulsivity, and/or distractibility, in addition to the other behaviors.

What is going on in the body?

In people who have AD/HD, the parts of the brain areas that control attention use less glucose than in other individuals. This indicates that the areas are less active. The lower activity level seems to cause inattention. Researchers are also finding problems in other areas of the brain in people with AD/HD. No one knows for sure why these brain areas are less active.

Risks

What are the causes and risks of the condition?

No one knows the exact cause of AD/HD. Most experts believe that the following factors may play a role in causing AD/HD:
  • environmental toxins, such as lead
  • genetics
  • smoking or alcohol use by the mother during pregnancy
  • use of illegal drugs, such as cocaine, by the mother during pregnancy
AD/HD is thought to affect 5% to 10% of school-age children. Boys are 10 times more likely than girls to be affected by AD/HD.

Prevention

What can be done to prevent the condition?

Many times, AD/HD cannot be prevented. However, these measures may be helpful:
  • avoiding pregnancy risk factors, such as drugs, alcohol, and smoking
  • obtaining good prenatal care beginning in the first trimester of pregnancy
  • taking steps to avoid lead poisoning in the environment

Diagnosed

How is the condition diagnosed?

Diagnosis of AD/HD begins with a medical history and physical exam. The healthcare provider will look for behaviors that are typical of AD/HD.
In order to diagnose AD/HD, the provider must determine that the behaviors have the following characteristics:
  • are more frequent or severe than in other people of the same age group
  • create significant disability in at least two of the following areas: school, home, work, or social settings
  • have continued for at least 6 months
  • started early in life, before age 7
The healthcare provider may order some of the following tests to rule out other disorders:
  • allergy tests
  • blood and urine tests
  • cranial CT scan
  • cranial MRI

Long Term Effects

What are the long-term effects of the condition?

Without effective treatment, AD/HD can cause serious problems at school, home, work, and in social settings.

Other Risks

What are the risks to others?

AD/HD is not contagious and poses no risk to others. There may be a genetic component to the disorder.

Treatments

What are the treatments for the condition?

Treatment for AD/HD usually involves medicine along with one or more other strategies. The most common medicine for AD/HD is a stimulant called methylphenidate. This medicine is available in a number of name-brand products, such as Ritalin, Concerta, or Metadate.
Other medicines used to treat AD/HD include the following:
  • amphetamines, such as Adderall, Dexedrine, or Dextrostat
  • antidepressants, such as desipramine (i.e., Nerpramin) or bupropion (i.e., Wellbutrin)
  • medicines normally used to treat high blood pressure, such as clonidine (i.e., Catapres)
Medicines are often used together with other treatment strategies, such as:
  • cognitive behavioral therapy
  • emotional counseling
  • practical support for activities of daily living
  • psychotherapy
  • social skills training for the individual
  • stress management training
  • support groups

Side Effects

What are the side effects of the treatments?

Side effects from medicine can include the following:
  • headache
  • involuntary muscle movements
  • loss of appetite
  • mood changes as medicine wears off
  • sleep disorders
  • weight management problems
A person who is receiving any form of therapy may show an initial increase in negative behavior. This may last until new behaviors become routine.

After Treatment

What happens after treatment for the condition?

Treatment and monitoring of AD/HD can be lifelong for many patients, although for some, the symptoms seem to reduce or go away over time.

Monitor

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

Sources

"Attention-Deficit and Disruptive Behavior Disorders", V Sharma et al, in Psychiatry, A. Tasman et al, eds., 1997, pp. 667-682.

"Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence", CW Popper and RJ Steingard, in Synopsis of Psychiatry, RE Hales and SC Yudofsky, eds., 1996, pp. 681-774.

Diagnostic and Statistical Manual of Mental Disorders, Fourth Ed. American Psychiatric Association Press, 1994.

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